J Am Board Fam Med
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Review Case Reports
Breast Cancer Screening in Older Women: The Importance of Shared Decision Making.
Incidence of breast cancer increases with age up until age 80. Screening mammography has demonstrated efficacy in decreasing mortality from breast cancer among women between 50 and 74 years of age. ⋯ It will also present clear guidelines for primary care clinicians to follow that incorporate shared decision-making techniques, tools for estimating the risks and benefits of screening mammography, and strategies for integrating a patient's life expectancy and comorbidities into the decision-making process. We also emphasize the importance of using thoughtful communication strategies to fully engage older women in the breast cancer screening discussion.
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Few studies have examined how interventions designed to address physician burnout might impact female and male physicians differently. Our aim was to test whether there are gender differences in individual approaches to address burnout and/or in organizational support aimed at physician well-being. ⋯ We identified gendered differences in physician responses to burnout. Effectively mitigating burnout may require different individual-level approaches and different organizational support mechanisms for female and male physicians.
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In 2015, the Army Office of the Surgeon General adapted a Veterans Health Administration course for health care teams to implement holistic health practices to improve the resiliency of health care teams and patient care. The Army course Move to Health was piloted in health care teams at 8 military clinics. During the 20-hour course, health care teams learned techniques to improve their resiliency and created action plans to incorporate holistic health into the workplace, a known factor in decreasing burnout. ⋯ Informed by the literature, Move to Health combines an individual resiliency intervention with organizational change, facilitating action plans to mitigate burnout. This manuscript explores potential reasons for why burnout did not significantly change within the 2-month period following the intervention. Reducing burnout among health care teams is vital to ensure that optimal health care is provided to the military and its beneficiaries.
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Patient portals have both patient-centered benefits and substantial impacts on practices. Successful implementation of a patient portal can be achieved with a comprehensive team approach. ⋯ Practice adaptations are necessary to manage volume, length, and complexity of messages. Dedicated staff with specialized training to handle patient messages and ample protected time for providers are important to minimize clerical burden associated with patient portal use.
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The CMS Transforming Clinical Practice Initiative (TCPI) provided coaching and learning support to practices during transition to new models of value-based care. Maryland ambulatory practices participated in the Garden Practice Transformation Network (GPTN) as a part of the TCPI. During practices assessment, we measured prevalence of burnout and identified its remediable predictors among GPTN-Maryland practices. ⋯ The Mini Z-derived T/T score could be useful for quick assessment of the degree of burnout and identifying burnout drivers related to effective organizational structure and supportive teamwork in practice personnel.